CES ECMO Indications & Patient Selection 2 — Questions and Answers
Question 1: Which pediatric condition most commonly requires VA ECMO support?
- Bronchiolitis
- Congenital heart disease post-surgery (Correct answer)
- Asthma exacerbation
- Pneumonia without cardiac involvement
Correct answer: Congenital heart disease post-surgery
Congenital heart disease following surgical repair is the most common indication for VA ECMO in the pediatric population.
Question 2: The SAVE score is used to predict survival in which ECMO population?
- Neonates on VV ECMO
- Adults on VA ECMO for refractory cardiogenic shock (Correct answer)
- Pediatric patients on VV ECMO
- Adults with ARDS on VV ECMO
Correct answer: Adults on VA ECMO for refractory cardiogenic shock
The SAVE (Survival After Veno-Arterial ECMO) score predicts survival in adults with refractory cardiogenic shock on VA ECMO.
Question 3: Persistent pulmonary hypertension of the newborn (PPHN) refractory to iNO is an indication for which ECMO modality?
- VV ECMO if cardiac function is preserved (Correct answer)
- VA ECMO exclusively in all cases
- Either VV or VA ECMO depending on cardiac function
- ECMO is contraindicated in neonates with PPHN
Correct answer: VV ECMO if cardiac function is preserved
VV ECMO is preferred for PPHN when cardiac function is preserved, reserving VA ECMO for cases with concurrent cardiac failure.
Question 4: Which pre-ECMO factor is associated with worse outcomes in respiratory ECMO candidates?
- Age 20–35 years
- Mechanical ventilation > 7 days before cannulation (Correct answer)
- PaCO2 > 50 mmHg
- History of asthma
Correct answer: Mechanical ventilation > 7 days before cannulation
Prolonged mechanical ventilation before ECMO initiation (>7 days) is associated with significantly worse survival outcomes.
Question 5: An awake ECMO strategy (ECMO without intubation) is primarily used to achieve what goal?
- Reduce anticoagulation requirements
- Avoid ventilator-induced lung injury and preserve respiratory muscle function (Correct answer)
- Decrease circuit priming volume
- Allow patients to ambulate during ECMO for bridge to heart transplant only
Correct answer: Avoid ventilator-induced lung injury and preserve respiratory muscle function
Awake ECMO avoids ventilator-induced lung injury and preserves diaphragmatic function, improving rehabilitation potential.
Question 6: Which echocardiographic finding would most strongly support transitioning from VV to VA ECMO?
- Mild tricuspid regurgitation
- Severely reduced left ventricular systolic function with hemodynamic instability (Correct answer)
- Moderate mitral regurgitation
- Elevated pulmonary artery pressures with preserved RV function
Correct answer: Severely reduced left ventricular systolic function with hemodynamic instability
Severely reduced LV systolic function causing hemodynamic instability requires cardiac support that only VA ECMO can provide.
CES ECMO Indications & Patient Selection 2
Which pediatric condition most commonly requires VA ECMO support?